Post #730: A perfect storm in Arizona

Redder = worse.  Source:  Analysis of state-level COVID-19 counts and state populations.  This map shows a measure of the rate of accumulation of new COVID-19 cases per capita.

Today, Virginia recorded another 624 COVID-19 cases, and Fairfax County recorded another 42.  So we haven’t beaten this yet, by any stretch of the imagination.  But it remains under control.

I don’t think that’s just a matter of good luck.  In Post #729, I laid out the three things that I believe allowed Virginia to re-open some businesses without having a flare-up in new coronavirus cases.  Those are:  Good government, good climate, and good people. 

Based on reporting in today’s Washington Post, it looks like Arizona is zero-for-three on that scale.  And they are now beginning to pay the penalty for that.  Just from glancing at the news, I knew these folks had done some fairly nutty stuff.  But I didn’t quite fathom the breath and depth of the stupidity until I read through that article.

Read the article if you want to know the stupidity in detail.  Here, let me just try to extract some positives from that.

First, on climate, it looks like epidemiologists are waking up to the role of air conditioning in all of this.  And now I have a name for what I called “good climate” in my prior posting.  The opposite of having a livable summer climate is described this way (emphasis mine).

In Southern states, some epidemiologists also are cautioning about what they are calling a “reverse summer effect,” with warm weather — once thought to interrupt the spread of the virus — driving residents into indoor spaces with recycled air.

Source:  Washington Post

More temperate US states might show a summertime drop in COVID-19 cases, similar to that observed for other human coronaviruses (see Post #714).  But if the climate is so hot that it drives everyone inside, you may not see that at all, in a population with no native immunity to the virus.  The additional indoor proximity might increase the number of new cases.  Hence, reverse summer effect.

Second, on good government, Arizona seems to have tested a strategy largely consisting of this:

This pretty much mirrors early (and sometimes current) national Republican strategy.  I would like to say that the failure of this approach should serve as a lesson to others, but the failure at the national level certainly didn’t deter Arizona from adopting it at the state level.  Perhaps spectacular failure at the state level will at least deter other governors who are considering adopting this approach moving forward.

They denied there was a problem until they absolutely could not deny it any more.  Arguably the most hilarious aspect of it was that, even after seeing videos of bars packed with maskless patrons, the official State line was that such behavior was not occurring in Arizona.  Or mostly not.  Or something.  In effect, they refused to see the evidence.  (This was in addition to the usual kill-the-messenger behavior that seems to crop up as a Republican strategy in this area.  So, consistent with a President who didn’t want much testing done, so we wouldn’t know how many cases there were, here, the governor tried to fire the group of academics who had predicted a resurgence in cases.  Said prediction having been done at the request of the State government.  I guess that was their penalty for being correct?)

But on top of that, so fervently did they let political ideology override public health policy that they literally prevented local governments from requiring masks in public.  So it wasn’t enough to have no mandatory state policy, the state actually took steps to prevent there from being any local policies.  Literally took their own bad judgement and overrode anyone who might have had better judgment.  That particular blunder was only rescinded about a week ago.

I refer you Post #721, the Missouri hair salon where 140 customers didn’t get infected by the two infected hair stylists.  And the only reason that happened is that the local government had put a mandatory mask ordinance in place.  So, Missouri was on a par with Arizona in terms of state mask policy, but at least they had to good sense to allow localities to impose stronger standards if they wanted to.

Anyway, the plausible good here is that other states just might wise up, once they see the crap hit the fan in Arizona.  That will be some good to come from what is otherwise shaping up as a fairly large failure.  If nothing else, if this deters the next governor from making happy talk while Rome burns, it may have been worth it.

Good people.  And so, to complete the trifecta, sure enough, you’ve got local politicians leading anti-mask rallies. In about as offensive a way as possible.  Read it yourself if you want to.   You’ve got state political leaders who still refuse to wear masks.  Local law enforcement that pro-actively said they would not enforce COVID-19 rules.

Pretty much every layer and facet of Arizona government being just about as butt-headed as they can get away with.  And, surprise surprise, given that leadership, Arizona seems to have a population that is highly non-compliant when it comes to mask use and social distancing.  Funny how that works.

Hey, you know what I’ve never seen?  I’ve never seen a bunch of health care workers leading an anti-mask rally.  I’ve never seen health care workers claim that they can’t breathe, due to wearing a mask.  And so on.  People who have no skin in the game feel free to mouth off with whatever nonsense strikes their fancy.  With the help of social media.  But you don’t see that stupidity coming from the people who are actually going to have to treat — and be exposed to — all these new COVID-19 cases.  You want to know whether or not we should be wearing masks in public?  I suggest you ask a hospital nurse Rather than listen to some local Republican hack.

Here’s what I see as the purely craziest aspect of the anti-maskers: They seem to be getting their information from social media.  And they don’t seem to realize quite how risky that is, in this case.

If I ran a foreign government, and wished to do as much damage as possible to the US for the least amount of money, I’d generate a lot of social media posts and websites to spread disinformation about mask use.  Right at this juncture, there’s probably no more cost-effective way to attack the US than that.  Do your part to keep the pandemic alive and well in the USA.

Now think about all these social media “influencers” who cite their cut-and-pasted nonsense about how bad masks are.  I would bet that in many cases, the ultimate source of what they are citing is foreign government disinformation.  That would certainly make sense.

And so, in my view, all these folks who are posturing on masks are probably, at root, pressing for their freedom to believe (e.g.) Russian disinformation.  And, this being America, you are free to believe that.  But if you don’t see the risks inherent in trusting nameless social media sources on this issue, then, well, you’re just not very bright.  Which, come to think of it, is probably true of the anti-mask crowd.


Sidebar:  Younger cases means that this is probably not a new peak in severity-adjusted new cases per day.

One oddity of these new outbreaks (Arizona, Texas, California, and others) is that the new cases tend to be much younger than the historical average.  Oddly, that actually gives Arizona and the other states some breathing room, as each new case there should generate fewer new hospitalizations and deaths than would otherwise be the case.

Using data from Virginia, it’s easy enough to calculate the magnitude of this effect.  Here’s what the hospitalization and mortality case rates look like in Virginia.  To date, averaged across all age groups (and so, not shown below), just over 10% of all diagnosed cases have been hospitalized, and just under 3 percent of all diagnosed cases have died.

And so, for the record, for the dumbasses who still maintain that this is no worse than seasonal flu, the typical flu death rate is also a case rate.  That is, as with the COVID-19 death rate above, the typically-quoted 0.1% flu death rate is flu deaths over diagnosed flu cases.  So the 3% mortality case rate in Virginia, for COVID-19 is comparable to that 0.1% mortality case rate for seasonal flu.  That’s an apples-to-apples comparison.  What you can’t do — but all the dumbasses do do — is throw in some estimate all the un-diagnosed cases of COVID-19 and claim a much lower death rate for COVID-19.  And then compare it to that same 0.1% flu rate.  That is not an apples-to-apples comparison.  So if you see that, you’re looking at somebody who either doesn’t know what a case rate is, or knows and is being purposefully misleading.  And mortality is far from the only outcome, as many who are hospitalized are leaving the hospital with permanent organ damage.  I don’t think you see that with flu.  I friend sent along a link to this article.  Read that and see if you think COVID-19 is no worse than the flu.

Source:  Analysis of demographic data from the Virginia Department of Health.

It’s easy enough to take the underlying data and ask what would happen if we shifted to a population with more young people.  In Virginia, to date, young adults (age 20-29) account for about 16% of cases.  If I boost that up to 50% in the 20-29 age group (but otherwise keep the age distribution constant), I would get a 30% reduction in hospitalizations, and a 40% reduction in deaths, for the same number of cases.  So if the casual statements that “half the new cases are young adults” are correct, Arizona and similar states will see substantially fewer hospitalizations and deaths per new case.

Let me invert those numbers to show you what I mean by that.  If the Arizona cases are as young as I just modeled, then it will take Arizona roughly 140 cases to generate as many new hospitalizations as Virginia does with 100 cases.  In effect, in terms of hospital resource use, they get an 40 cases for free, owing to their much younger age.  And if we take death as a proxy for ICU use, they get 65 case for free, in terms of ICU.

If they get enough new cases, they will eventually overrun their hospital system.  But due to the much lower average age, that will occur at a slower rate than you would expect from the raw case counts alone.

In effect, the low age means that the raw case count increases in Arizona (and presumably Texas and California) are NOT directly comparable to the case counts that occurred historically in this pandemic.  To the extent that they are younger, they will not be as hospital-intensive, ICU-intensive, or deadly as these cases were, on average, in the past.  We are setting records for the raw daily case count, sure.  But on a severity-adjusted basis (accounting for lower average severity in younger people), I bet that’s not so.

And so, despite what you will read in the newspapers, the pandemic at this point is probably not as bad as it was at the former new-cases peak.  More new cases, sure.  But likely fewer hospitalizations and deaths per new case.

I guess that’s cold comfort, given how rapidly the new cases are piling up.  But that’s better than no comfort at all.